If your child is experiencing recurring migraine attacks, you probably have dealt with missed school, skipped practices and afternoons in a dark room. Pediatric migraine makes it tough to enjoy being a kid, and it is more common than most families realize. Migraine affects about 10% of children ages 5 to 15 and 28% of teenagers.

Pediatric migraine attacks occur from abnormal brain activity, changes in neurotransmitters and vascular changes that affect how the brain processes pain and other sensory information. It is not just muscle tension, stress or simply a bad headache.

Although head pain is a common symptom, migraine causes much more than pain. Children also may experience nausea, vomiting, sensitivity to light or sound, dizziness, fatigue and changes in mood or behavior.

Not all headaches are caused by migraine. If you’re looking for information about other types of headaches in children, visit our pediatric headache page.

At Norton Children’s Neuroscience Institute, our pediatric migraine treatments are tailored to each child’s needs and unique symptoms. As pediatric migraine researchers, our physicians have access to innovative treatments through cutting-edge research and clinical trials.

What Is Pediatric Migraine?

Pediatric migraine is a neurological disorder. Stress, muscle tension and being overtired can trigger an attack in a susceptible child, but they are not the underlying cause. Migraine responds to treatment aimed at the cause rather than only at the pain.

Children with migraine experience recurring attacks separated by periods when they feel completely well. An attack may include head pain along with nausea, vomiting, sensitivity to light or sound, dizziness, fatigue or other neurological symptoms.

Migraine symptoms also change as a child grows. Younger children are more likely to have difficulty describing their symptoms, tend to have shorter attacks and often feel pain across both sides of the head rather than one side. In older children and teens, symptoms begin to look more like the typical migraine symptoms reported by adults.

Four Types of Pediatric Migraine

Migraine is not a single condition. Several distinct types of migraine affect children, and some of them may be easy to miss because they don’t always involve head pain.

Episodic Migraine With or Without Aura

Migraine without aura is the most common type and occurs fewer than 15 days a month. Migraine with aura is an additional symptom that involves an unusual sensation, usually visual disturbances like spots or flashes, that occurs before or during a migraine.

Chronic Migraine

Chronic migraine means headache pain for at least 15 days a month, with at least eight of those days qualifying as migraine attacks, causing severe disruption to daily activities.

Abdominal Migraine

Abdominal migraine involves no head pain. Instead, a child has recurring episodes of nausea, vomiting or stomach pain. It is most common in younger children and is frequently mistaken for a stomach virus or digestive issue.

Vestibular Migraine

Vestibular migraine causes dizziness and balance issues, which may occur with or without head pain.

Recognizing Migraine Symptoms Across Age Groups

Migraine does not always begin when the head pain starts. Some children show symptoms hours before pain develops; others experience an aura shortly before or during an attack.

Prodrome and Early Warning Signs

The prodrome is an early phase that can begin up to 24 hours before an attack. Parents or children may notice:

• Unusual fatigue
• Frequent yawning
• Irritability or mood changes
• Difficulty concentrating
• Food cravings
• Changes in energy or activity

Recognizing these early patterns can help families identify when an attack is beginning, and sometimes act with preventive measures before a migraine fully develops.

What Is a Migraine Aura in Children?

An aura is a temporary neurological symptom that typically lasts 5 to 60 minutes and occurs before the headache phase begins. Migraine with aura affects roughly 10% to 20% of children with migraine and may cause:

• Flashing lights
• Spots or shapes in the field of vision
• Zigzag lines
• Changes or gaps in vision
• Tingling in the face or hands
• Difficulty finding or saying words

Aura symptoms usually develop gradually and resolve completely. Because new vision, speech, sensation or movement changes also can signal other medical conditions, a child experiencing these symptoms for the first time should be evaluated by a healthcare provider.

Migraine Symptoms: Toddlers vs. Teens

In toddlers and young children, migraine symptoms often show up as behavior rather than a complaint about pain. Parents may notice:

• Pounding pain across both sides of the forehead, if the child is able to describe it
• Sudden pale skin
• Sudden fatigue or decreased activity
• Crying or irritability
• Unexplained vomiting or nausea
• Abdominal pain
• Sensitivity to light or sound
• Holding or rubbing the head
• Wanting to sleep or lie down in a dark room

In teens and older children, migraine symptoms usually are easier to describe:

• One-sided or bilateral throbbing pain
• Severe sensitivity to light, sound or smells
• Nausea or vomiting
• Dizziness
• Vision changes
• Difficulty concentrating
• Pain that worsens with normal physical activity

Common Childhood Migraine Triggers

A trigger does not cause the underlying neurological issue, but it can make an attack more likely in a child who is susceptible to migraine. Childhood migraine triggers vary considerably from one child to another.

Hydration and meals

• Dehydration
• Missed meals or long stretches between meals
• Fluctuating blood sugar

Sleep hygiene

• Inconsistent sleep schedule
• Sleep deprivation
• Oversleeping, which triggers attacks in some children just as reliably as too little sleep

Stress and environment

• Academic or social pressure
• Storm systems and barometric pressure changes
• Bright sunlight
• Loud environments and strong smells

Hormonal and dietary factors

• Onset of puberty and menstruation
• Excessive caffeine
• Some processed foods or ingredients

Foods are sometimes reported as triggers, but families generally do not need to eliminate certain foods unless a consistent pattern has been identified. Keeping a migraine diary is the more reliable approach: record when an attack occurs, along with sleep, meals, hydration, activities, stress, symptoms and any medication used. Over time, this information will help your child’s healthcare provider identify likely triggers and build a treatment plan.

When to Seek Emergency Care

Some migraine-like symptoms may signal a more serious condition and need immediate evaluation.

Call 911 or go to the nearest emergency room if your child has:

• A sudden, extremely severe headache that peaks within seconds
• A headache with high fever and a stiff neck
• Persistent vomiting, confusion or unusual sleepiness
• A headache that wakes your child from sleep or is worse early in the morning, especially with vomiting
• A headache following a fall, sports injury, car crash, head injury or concussion
• Weakness in the arms or legs, or drooping on one side of the face
• Numbness, trouble walking, trouble talking or loss of balance
• Significant changes in vision
• A seizure
• A sudden or significant change in behavior, personality or alertness

Acute Rescue Treatments

Acute treatment, also called “rescue treatment,” is used during an attack to stop it early and help your child return to normal activities. Depending on age and medical needs, it may include:

• Fast-acting, age- and weight-appropriate pain medications
• Migraine-specific medications, such as pediatric triptans
• Antinausea medication
• Rest in a quiet, dark environment
• Fluids and hydration

Follow your child’s individualized plan. Do not start or change migraine medication without guidance from a healthcare provider.

Preventive Therapies and Behavioral Approaches

Children with frequent or disabling attacks may benefit from preventive treatment, which usually combines medical, behavioral and lifestyle strategies:

• Daily preventive prescription medication
• Cognitive behavioral therapy
• Biofeedback
• Stress management strategies
• Behavioral health support
• Nutraceuticals, such as magnesium oxide, riboflavin or CoQ10 when recommended by a provider
• Lifestyle habits, including nutrition, sleep and exercise

For children whose symptoms remain difficult to control, additional options, such as Botox and acupuncture, may be considered when medication alone isn’t providing enough relief.

Specialized Pediatric Migraine Care at Norton Children’s

At Norton Children’s Neuroscience Institute, we believe your child deserves to be migraine-free and able to enjoy life just like any other kid. Our multidisciplinary team includes pediatric neurologists, pediatric headache medicine physicians and psychologists who specialize in diagnosing migraine and designing treatment plans for children and teenagers.

We conduct a thorough medical history and examination, and continue to evaluate your child at regular visits to monitor attacks and quality of life. Treatment is individualized based on your child’s age, symptoms, how often attacks occur, medical history, and how migraine is affecting school, activities and daily life.

Our treatment goals for every child include:

• Reduce how often migraine attacks happen
• Shorten the duration and lessen the severity of each attack
• Decrease the number of days pain medication is needed
• Eliminate missed school and extracurricular activities
• Create an action plan that reduces anxiety when your child feels an attack coming on

If your child is experiencing recurring migraine symptoms, talk with your child’s pediatrician or schedule an appointment with a pediatric headache specialist at Norton Children’s Neuroscience Institute.